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The Affordable Care Act (ACA) has dramatically altered the health insurance field, sparking a need for new strategies. For now, the U.S.
government has pushed back the deadline for the employer mandate to 2015 and will not penalize businesses that fail to provide health insurance next year1.

Nevertheless, brokers should take advantage of such delays to help clients prepare. With private exchanges, employers provide employees with money to purchase coverage, and the employee then picks a coverage level and insurance network based on health needs, employer contribution, provider network participation and risk tolerance2.

Given the complexity involved, health plans and carriers in a private exchange must combine technology and human advocacy, and include online eligibility verification and mechanisms which allow employers who connect individuals with exchanges to offer subsidies.

Brokers represent an important piece in this puzzle, acting as navigators and expertly guiding clients in purchasing a plan that is right for them. Toward this end, brokers should offer private exchange solutions that can meet consumer demand for convenient, streamlined information and access. Mobile technology platforms that feature smartphone apps and online tools are ideally suited for this purpose and empower consumers to more appropriately use their medical and prescription benefits.

With the likelihood that high deductible (greater than $1,000 per covered person) health plan coverage will be more attractive to consumers due to lower monthly premiums, insured customers could benefit from pharmacy-specific tools and platform applications
to help understand and manage the potentially high retail expenses from prescription drugs as part of their new health plan coverage. Technology plays a crucial role in managing the pharmacy benefit expenses consumers will face as they purchase various health insurance policies from the private exchanges.
Instant access

Privately run exchanges with participating insurers will require the ability to provide instant access to information. A single-source mobile technology platform can influence stakeholder access to information, help improve individual member behaviors, and lower rates by improving overall workforce health and productivity.

The goals are to streamline the flow of information between health plans, physicians and patients, to facilitate one-on-one exchanges that close gaps in care, to shorten medical response times, and to improve the overall health care system.

Ideally, one technology platform should power the various technology applications and products of a private exchange, integrating data from the sponsoring health plan, pharmacy benefit manager (PBM), or other source into a single member-centric data set that is accessible to multiple software solution sets.

Mobile technology features enable health plans and PBMs to interact with members and providers anywhere they have their mobile phones — whether it’s at the point-of-care, pharmacy or dinner table — and at any time of the day. A mobile application suite should offer a completely configurable approach to placing mobile decision-support tools into the hands of members and patients: medication history and drug look-up, drug savings calculations and plan benefit options, personalized messages, biometric trackers and physician office visit preparation application, to name a few.

Health-related apps are used primarily for information retrieval, with some mobile devices providing more one-on-one interaction. For example, a mobile platform can deliver personal drug utilization information for each plan member, including specific money-saving suggestions for better pharmacy benefit use.

With the ability to funnel a wealth of information into the right place at the right time — where and when the patient needs it — the right private exchange solution can empower members to make better, more well-informed choices that can increase prescription drug
adherence, reduce costs associated with emergency care, and improve the overall quality of health care.

Apps can also serve as decision-support tools for health care providers and PBMs, allowing them to quickly suggest additional prescription drug purchasing channels, such as mail order and retail discount options.

What’s more, a thoughtful and engaging mobile-access and mobile-platform technology strategy can greatly simplify the management of
chronic diseases and reduce the cost burden of unhealthy lifestyles and aging
populations.

The revolution of insurance benefits — and how they are accessed — is influenced by legislation, advances in technology, consumer expectation and economic pressures. Mobile apps will serve private exchange solutions and enable brokers, employers and consumers to keep their footing in a complex and ever-changing health care environment. For brokers, in particular, offering a private exchange solution that features a mobile technology platform can provide a competitive edge in a shrinking marketplace.

About the Author

Robert Oscar, R.Ph., has more than 25 years of experience in healthcare. Throughout much of his career, Oscar has developed and implemented successful programs to effectively manage pharmacy benefit risk including pioneering work in the Medicare HMO market. Before founding RxEOB more than a decad... More